ER departments too full for safe care.

Mobeeb, RN · Jun 1, 2008

I work in ED of Level 1 Trauma Center and we are bursting at the seams. Unfortunately the Academy of Medicine in our city has prohibited any ED's to divert patients. So, we pack, stack and rack the ambulance cots in the hallways until the next available bed is ready. There are 6 other large hospitals in our city and a childrens' hospital. All of them are feeling the crunch. But, we're the only trauma center in town and it seems that EMS thinks all MVC's, assaults, etc., should come to us. *sigh*

snowfreeze, BSN, RN · Jun 1, 2008

I feel for you, I as a nurse on a tele unit see the difference in the reports I get now in comparison to reports in the last 16 years. No one know much about the patient as someone else triaged and someone else cared for for 3 hours then someone else had them and now I am given the task of admitting to the unit. The staff is so stressed that they dont give me a quick pertinent report as they dont really know the patient.

Blee O'Myacin, BSN, RN · Jun 1, 2008

http://news.yahoo.com/s/usatoday/20080530/cm_usatoday/ourviewonmedicaltreatmentailingersthreatenpatientsleavecommunitiesvulnerable
On the night of her baby's seizure in February, Brandy Nannini discovered a harsh reality of today's overtaxed medical system. The ambulance crew that responded to her 911 call refused to take 23-month-old Bella to a nearby Washington, D.C., hospital where her doctor was waiting. The emergency room was so crowded it was closed to new patients. Despite Nannini's pleas, the ambulance was diverted to suburban Virginia.

I wonder if her doctor was "waiting" for real, or if the doctor told the parents to call 911 and the parents, like most patients, assume their personal doctor is waiting at the ambulance bay. Unless we have a physician call a patient in as a private (which the article didn't mention if this was the case), then they are triaged like everyone else and seen by our ER team first.

Thankfully, the end result was a positive one for this child. And I'm sure it was difficult for the parents to have been taken to an unfamiliar hospital.

Blee

TriageQueen · Jun 2, 2008

I want to know where they surveyed because my ED definitely sees more than 14% or cases that are non-urgent! And I have worked in the areas mentioned in the article, very large non-insured populations. At least once a shift we have people come to the triage window asking how long the wait is, and then trying to decide whether it would be better to make a doctor's appointment in the morning. To those people I want to scream "if you can think about whether or not to be seen, it is not an emergency!"... oh yeah, and btw there is an urgent care center literally right across the street from our hospital.

And more on point, simply sending patients up to the other units without having a bed available is not necessarily a great solution... who will watch these patients upstairs to make sure they don't die there? However, I think we should be able to send the patient up to wait in the hallway while the other patient is gathering their things to leave, or the room is being cleaned (which somehow seems to take 4 hours sometimes), but not if there is no staff, because that is not safe either.

Altra, BSN, RN · Jun 2, 2008

I wonder if her doctor was "waiting" for real, or if the doctor told the parents to call 911 and the parents, like most patients, assume their personal doctor is waiting at the ambulance bay. Unless we have a physician call a patient in as a private (which the article didn't mention if this was the case), then they are triaged like everyone else and seen by our ER team first.
Thankfully, the end result was a positive one for this child. And I'm sure it was difficult for the parents to have been taken to an unfamiliar hospital.
Blee

Very, very true. Patients call MDs who say, "I think you need to come in to the hospital." What they mean is that they know the patient will likely need admission and will be admitted to their service.

What the patient "hears" is, "come in to the ER, I will be there waiting for you, there will be an empty bed held for you, and the ER staff will be waiting to take care of you."

I understand the breakdown in communication, and I attempt to give patients/families a little education on the process and how to get more specific information from their PCPs. It's disheartening to hear a distressed patient insist that, "Dr. X said he was going to call here" or "my doctor said he would see me here" when there has been no call, no fax, no nothing (and it wouldn't change anything even if there had been some communication) ... and when you know that it's more likely that Jesus Himself will appear in the ER to minister to the sick than it is that Dr. X will show up at 2200 on a Friday night.

bill4745, RN · Jun 3, 2008

What the patient "hears" is, "come in to the ER, I will be there waiting for you, there will be an empty bed held for you, and the ER staff will be waiting to take care of you."

Thank you! I thought I was the only one who hears this.

TraumaNurseRN · Jun 4, 2008

i know i am not the only er nurse who feels there is no reason non-emergent patients are able to sit out in the triage area. it's management's decision to want everyone back asap. these "blue-coats" as we call them do not have a clue....it's all press ganey. when i am out in triage i don't push the patients back....and figure if the blue coats wanna come talk to me they are certainly free to do so, but i don't leave the desk....they can come to me...lol

darius000 · Jun 4, 2008

i know i am not the only er nurse who feels there is no reason non-emergent patients are able to sit out in the triage area. it's management's decision to want everyone back asap. these "blue-coats" as we call them do not have a clue....it's all press ganey. when i am out in triage i don't push the patients back....and figure if the blue coats wanna come talk to me they are certainly free to do so, but i don't leave the desk....they can come to me...lol

i work in ed in perth western australia. we are a tertiary level hospital and the states designated trauma centre. we have a 5 level triage scoring system:

1 = life threatening - straight in seen immediately

2 = should be seen by dr within 10 minures

3 = should be seen within 30 minutes

4 = 1 hour

5 = 2 hours.

obviously with the workload it does not happen, 1's and 2's generally get seen. we are trialling a system now where 3's 4's and 5's get seen in time of presentation order on the basis that a patient triaged as 3, 4 or 5 should not have a serious life or limb threatening problem. i quoted because i am not sure what you mean by "blue coats" or how your triage works. do you mean that all but the sickest are sent to a waiting area? here the triage nurse will either triage people to the waiting room, quick assessment area, or directly inside (or back i guess). also here in australia hospital care is basically free for all and having insurance makes no difference although there are some private ed's that the insured can attend.

**canoehead, BSN, RN** · Jun 5, 2008

darius, Do you mean you pull in all the 3's in order, then 4's, then 5's?

Or are they wanting the 4-5's pulled over the 3 that just came in?

You are looking at hours wait for abdominal pain because of the family packs that come ine with colds and dental pain for 3 months. That's not right.